Pilot implementation of a computer-based training course on newborn hearing screening and teleaudiology among primary healthcare providers in low resource settings

Objective@#Newborn hearing screening (NHS) in the Philippines has been mandated by law since 2009. However, lack of awareness and knowledge about NHS remains a challenge, especially among healthcare providers. This paper describes the pilot implementation of a computer-based training (CBT) course on NHS and teleaudiology among primary healthcare providers (PHCPs) in rural Philippines. @*Methods@#A four-module web-based training course on newborn hearing screening and teleaudiology in an online learning management system (LMS) was field-tested among PHCPs from eight rural communities in the Philippines. Participants were given four weeks to complete the course. @*Results@#Forty-two PHCPs participated in the CBT. Thirty-four (81%) completed the whole course (mean attrition rate of 4.8% per module) at a mean duration of 10.2 days. Baseline data shows that participants had no NHS training, although the majority (83%) had information and communications technology (ICT) training. Comparison of preand post-test mean scores showed a 24.0% (p<0.001) significant increase in the post-test in all four modules. Passing rates (i.e., score ≥70%) from pre- to post-test increased by 54.6% (range: 38-80% increase). Usability of the CBT was rated high with a mean score of 4.32 out of 5 (range: 4.13 to 4.47), covering all eight parameters. Participants expressed general satisfaction and a positive attitude on CBT to improve knowledge on NHS and teleaudiology. @*Conclusion@#Even in low resource settings where gaps in ICT infrastructure exist, eLearning can be used as an alternative approach to increase awareness and support training of healthcare providers on newborn hearing screening.

Design of a blended learning course for training community healthcare providers on ehealth-enabled newborn hearing screening

Objectives@#We present in this article the design and evaluation of a blended learning approach for training community healthcare providers in performing newborn hearing screening (NHS).@*Methods@#We developed a blended learning course for training community healthcare providers on eHealth-enabled NHS, following Bloom’s revised taxonomy of educational objectives. The training involved three components: computer-based training (CBT), face-to-face (FTF) training, and on-site coaching. We used surveys and post-training interviews following Level 1 Kirkpatrick’s training evaluation model to get initial feedback on the training program. @*Results@#Thirty-one community healthcare providers from five rural health units and a private hearing screening center, with a mean age of 42.2 ± 12.0 years, participated in the pilot. 93.5% of the participants agreed that the program content met stated objectives and was relevant to their practice. The length of the course was perceived to be adequate. Overall satisfaction with the program was rated at 8.5 ± 0.9 (with ten as the highest). The majority expressed that the CBT and FTF course were satisfactory at 93.5% and 100%, respectively. All participants agreed that the course enhanced their knowledge of newborn hearing screening and telehealth. Positive reviews were received from participants on the use of CBT to improve theoretical knowledge before FTF training. Participants declared that FTF training and on-site coaching helped improved NHS skills and implementation. @*Conclusion@#Competent community healthcare providers are critical to strengthening the performance of the health system, and advances in the education and technology sectors offer promising potential in upskilling local healthcare providers. The increasing access of Filipino healthcare providers to improved information and communications technology (ICT) is a significant catalyst for pedagogical innovation, like the use of blended learning in the continuous professional development of health practitioners. As ICTs gradually penetrate the health sector, the challenge we now face is not whether but how we can use innovations in education strategies to benefit healthcare providers.

Assessment of readiness for a community-based teleaudiology program of selected primary care health facilities in the Philippines

Introduction@#Access to appropriate and timely care underpins the Republic Act 9707 or the Universal Newborn Hearing Screening and Intervention Act of 2009. However, less than 10% of babies born every year have been screened for hearing loss. The Hearing for Life (HeLe) research program aims to increase the rate of newborn hearing screening (NHS) nationwide through the development and deployment of novel digital health or eHealth technologies in government rural primary care health centers (PCHC). The HeLe is also built on the global call for increased and systematic use of eHealth to strengthen health systems. Effectiveness of eHealth innovations requires acknowledgment of the product’s life cycle; one consideration is organizational readiness at this development stage of the HeLe. @*Objective@#This study assessed readiness of the eight PCHC selected to use the HeLe technologies. @*Methods@#This research utilized the Khoja-Durrani-Scott (KDS) eHealth evaluation tool to assess the PCHC’s readiness level prior to the implementation of HeLe. The KDS tool was distributed through a self-administered survey; data was analyzed using descriptive statistics. Readiness is measured in terms of seven dimensions or outcomes resulting from the use of the HeLe technologies. @*Results@#The study revealed that the eight PCHC were most to least ready, in decreasing order, in the following areas: Ethical, Health, Technology, Social & Cultural, Readiness & Change Management, as well as Economic, and Policy outcomes. The study affirms the PCHCs’ value for equity in health care, i.e., providing accessible NHS services in the community setting closest to where the families and their newborns are. Likewise, results confirm the PCHC staff’s preparedness for another set of innovations, through agreement with statements on Technology, Social & Cultural as well as Readiness & Change Management parameters. @*Conclusions@#The results informed the training and technical support strategies to be implemented by the HeLe program proponents. However, even in this early development phase of the HeLe technologies, the PCHC are already concerned with how to sustain NHS services after the research. Fully aware that the HeLe ICT tools need to be maintained and upgraded, the PCHC views that economic and policy support should also be in place to ensure continuous delivery of the ICT-enabled NHS services. While results are illustrative, usefulness is limited by the small sample size and character of the study sites. Nevertheless, social dimensions still have to be carefully considered as innovative NHS tools are introduced to primary care health workers nationwide. Researchers have to be deliberate in working with broader health systems and policy advocacy efforts to allow novel NHS technologies to be smoothly introduced at the community level and frontlines of care.

Pilot implementation of a community-based, eHealth-enabled service delivery model for newborn hearing screening and intervention in the Philippines

Objectives@#This study explores the potential of the HeLe Service Delivery Model, a community-based newborn hearing screening (NHS) program supported by a web-based referral system, in improving provision of hearing care services. @*Methods@#This prospective observational study evaluated the HeLe Service Delivery Model based on records review and user perspectives. We collected system usage logs from July to October 2018 and data on patient outcomes. Semi-structured interviews and review of field reports were conducted to identify implementation challenges and facilitating factors. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. @*Results@#Six hundred ninety-two (692) babies were screened: 110 in the RHUs and 582 in the Category A NHS hospital. Mean age at screening was 1.4±1.05 months for those screened in the RHU and 0.46±0.74 month for those in the Category A site. 47.3% of babies screened at the RHU were ≤1 month old in contrast to 86.6% in the Category A hospital. A total of 10 babies (1.4%) received a positive NHS result. Eight of these ten patients were referred via the NHS Appointment and Referral System; seven were confirmed to have bilateral profound hearing loss, while one patient missed his confirmatory testing appointment. The average wait time between screening and confirmatory testing was 17.1±14.5 days. Facilitating factors for NHS implementation include the presence of champions, early technology adopters, legislations, and capacity-building programs. Challenges identified include perceived inconvenience in using information systems, cost concerns for the patients, costly hearing screening equipment, and unstable internet connectivity. The lack of nearby facilities providing NHS diagnostic and intervention services remains a major block in ensuring early diagnosis and management of hearing loss in the community. @*Conclusion@#The eHealth-enabled HeLe Service Delivery Model for NHS is promising. It addresses the challenges and needs of community-based NHS by establishing a healthcare provider network for NHS in the locale, providing a capacity-building program to train NHS screeners, and deploying health information systems that allows for documentation, web-based referral and tracking of NHS patients. The model has the potential to be implemented on a larger scale — a deliberate step towards universal hearing health for all Filipinos.

Evaluation of an investigational hearing screening device (HeLe) to demonstrate acoustic brainstem response among normal-hearing adults

Objective@#This pilot human trial demonstrates the ability of the investigational newborn hearing screening device to provide acoustic stimulation to produce evoked potentials, as well as its ability to capture and acquire auditory evoked potentials, especially the auditory brainstem response (ABR) wave V. This pilot study also demonstrates the ease of recognizing and identifying ABR waves in the graphical presentation of the evoked potentials over time. @*Methods@#Fourteen normal-hearing adults or a total of twenty-eight (28) normal-hearing adult ears underwent auditory brainstem response testing using the investigational hearing screening device. A commercially available auditory brainstem response detection device was used to confirm that the acquired ABR waves of the investigational device are normal. The ABR waves displayed by the investigation device were also reviewed by the clinical audiologists to determine their recognizability and identifiability. @*Results@#The pilot trial demonstrates the ability of the investigational newborn hearing screening device in providing acoustic stimulation to produce evoked potentials, and in acquiring and capturing ABR waves, specifically the wave V, among normal-hearing adult ears. The clinical audiologists recognized and identified the ABR wave V among the evoked potentials at 40dB, 60dB, and 80dB acoustic stimulation. About eighty-nine percent (89.2%) of all ears tested had identifiable and recognizable wave V upon acoustic stimulation at 40dB. @*Conclusion@#The investigational hearing screening device: (1) can provide acoustic stimulation to produce evoked potentials, (2) can accurately capture and acquire these evoked potentials, (3) can present these evoked potentials in a voltage per time graphical display which an audiologist and trained HCP can easily read and interpret (diagnostic ABR), and (4) can present wave V auditory brainstem potentials that can be easily identified by an audiologist and trained HCP (screening ABR).

Sedentary behavior and physical activity: barriers and facilitators for active behavior during the COVID-19 pandemic / Comportamento sedentário e atividade física: barreiras e facilitadores para o comportamento ativo durante a pandemia de COVID-19

ABSTRACT Objectives: The objectives of the present study were to assess sedentary behavior and physical activity levels before and during the COVID-19 pandemic in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression, and also identify facilitators and barriers to physical activity in these populations. Methods: This is a cross-sectional survey based on a self-report questionnaire applied during the COVID-19 pandemic period. Results: In the total sample (N = 1,285) the prevalence of sedentary behavior (>8 hours/day) increased by 25% during social isolation. Social isolation increased sedentary time and decreased physical activity levels in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression. In both groups, the most prevalent facilitators were supervised physical activity (before the pandemic) and activities and equipment to practice at home (during the pandemic). The most prevalent barriers were the lack of time to perform physical activities (before the pandemic) and inaccessible or distance places to practice (during the pandemic). Conclusion: The COVID-19 pandemic is related to an increased sedentary behavior and reduced physical activity levels. Significant changes in perceived barriers and facilitators to exercise were observed during the social isolation period.

RESUMO Objetivos: Os objetivos do presente estudo foram avaliar o comportamento sedentário e os níveis de atividade física antes e durante da pandemia de COVID-19 em indivíduos saudáveis e com diagnóstico autorreportado de ansiedade e/ou depressão e identificar os facilitadores e barreiras para a prática de atividade física nessas populações. Métodos: Trata-se de uma pesquisa de corte transversal baseada em um questionário de autorrelato aplicado durante o período de pandemia da COVID-19. Resultados: Na amostra total (N = 1.285), a prevalência de comportamento sedentário (>8 horas/dia) aumentou em 25% durante o isolamento social. O isolamento social aumentou o tempo sedentário e diminuiu os níveis de atividade física em indivíduos saudáveis, com ansiedade e/ou depressão autorreportada. Nos dois grupos, os facilitadores mais prevalentes foram a atividade física supervisionada (antes da pandemia) e as atividades e equipamentos para a prática em casa (durante a pandemia). As barreiras mais prevalentes foram a falta de tempo para realizar atividades físicas (antes da pandemia) e os locais inacessíveis ou distantes para a prática (durante a pandemia). Conclusão: A pandemia de COVID-19 está relacionada a aumento do comportamento sedentário e redução dos níveis de atividade física. Mudanças significativas nas barreiras percebidas e facilitadores ao exercício foram observadas durante o período de isolamento social.

Web-based exercise interventions for patients with depressive and anxiety disorders: a systematic review of randomized controlled trials

Objective: The number of people suffering from depression and/or anxiety has increased steadily due to the coronavirus disease 2019 (COVID-19) pandemic. In this context, web-based exercise interventions have emerged as a potential treatment strategy. The objective of this study was to synthetize evidence from randomized controlled trials regarding the effects of web-based exercise interventions on patients with depressive and/or anxiety disorders. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Six databases were searched (Cochrane Library, EBSCO, PubMed, SciELO, Scopus, and Web of Science), and eligible articles were identified according to a PICOS inclusion-exclusion approach (participants with depressive or anxiety disorders; web-based exercise interventions; active or passive control group; assessment of changes in depressive or anxiety disorders; randomized design). Primary outcomes were depressive and/or anxiety symptoms. The quality of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. Results: Of 7,846 search results, three studies met the inclusion criteria (172 participants between 18 and 65 years of age, 95.9% women). The web-based exercise interventions lasted 8-12 weeks and involved endurance training, yoga, or combined endurance and strength training. The comparators involved non-exercise controls or active controls. Compliance rates were low. Web-based exercise interventions were not superior to controls regarding anxiety symptoms, and only one study found benefits for depressive symptoms (p ≤ 0.05). The quality of the cumulative evidence was low. Conclusion: The available data regarding the effects of web-based exercise interventions on depression and/or anxiety symptoms is scarce, the risk of bias is high, and the quality of the cumulative results is low. Currently, no clear recommendations can be provided. Registration number: PROSPERO CRD42021225938.

Management of isolated mandibular body fractures in adults

Objective@#The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults.@*Purpose@#This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others.@*Action Statements@#The guideline development group made strong recommendationsfor the following key action statements: (6) pain management- clinicians should routinely evaluate pain in patients with isolated mandibular body fractures using a numerical rating scale (NRS) or visual analog scale (VAS); analgesics should be routinely offered to patients with a numerical rating pain scale score or VAS of at least 4/10 (paracetamol and a mild opioid with or without an adjuvant analgesic) until the numerical rating pain scale score or VAS is 3/10 at most; (7) antibiotics- prophylactic antibiotics should be given to adult patients with isolated mandibular body fractures with concomitant mucosal or skin opening with or without direct visualization of bone fragments; penicillin is the drug of choice while clindamycin may be used as an alternative; and (14) prevention- clinicians should advocate for compliance with road traffic safety laws (speed limit, anti-drunk driving, seatbelt and helmet use) for the prevention of motor vehicle, cycling and pedestrian accidents and maxillofacial injuries.The guideline development group made recommendations for the following key action statements: (1) history, clinical presentation, and diagnosis - clinicians should consider a presumptive diagnosis of mandibular fracture in adults presenting with a history of traumatic injury to the jaw plus a positive tongue blade test, and any of the following: malocclusion, trismus, tenderness on jaw closure and broken tooth; (2) panoramic x-ray - clinicians may request for panoramic x-ray as the initial imaging tool in evaluating patients with a presumptive clinical diagnosis; (3) radiographs - where panoramic radiography is not available, clinicians may recommend plain mandibular radiography; (4) computed tomography - if available, non-contrast facial CT Scan may be obtained; (5) immobilization - fractures should be temporarily immobilized/splinted with a figure-of-eight bandage until definitive surgical management can be performed or while initiating transport during emergency situations; (8) anesthesia - nasotracheal intubation is the preferred route of anesthesia; in the presence of contraindications, submental intubation or tracheostomy may be performed; (9) observation - with a soft diet may serve as management for favorable isolated nondisplaced and nonmobile mandibular body fractures with unchanged pre - traumatic occlusion; (10) closed reduction - with immobilization by maxillomandibular fixation for 4-6 weeks may be considered for minimally displaced favorable isolated mandibular body fractures with stable dentition, good nutrition and willingness to comply with post-procedure care that may affect oral hygiene, diet modifications, appearance, oral health and functional concerns (eating, swallowing and speech); (11) open reduction with transosseous wiring - with MMF is an option for isolated displaced unfavorable and unstable mandibular body fracture patients who cannot afford or avail of titanium plates; (12) open reduction with titanium plates - ORIF using titanium plates and screws should be performed in isolated displaced unfavorable and unstable mandibular body fracture; (13) maxillomandibular fixation - intraoperative MMF may not be routinely needed prior to reduction and internal fixation; and (15) promotion - clinicians should play a positive role in the prevention of interpersonal and collective violence as well as the settings in which violence occurs in order to avoid injuries in general and mandibular fractures in particular.

Routing to Endovascular Treatment of Ischemic Stroke in Korea: Recognition of Need for Process Improvement

Background@#To track triage, routing, and treatment status regarding access to endovascular treatment (EVT) after acute ischemic stroke (AIS) at a national level. @*Methods@#From national stroke audit data, potential candidates for EVT arriving within 6 hours with National Institute of Health Stroke Scale score of ≥ 7 were identified. Acute care hospitals were classified as thrombectomy-capable hospitals (TCHs, ≥ 15 EVT cases/year) or primary stroke hospital (PSH, < 15 cases/year), and patients' initial routes and subsequent inter-hospital transfer were described. Impact of initial routing to TCHs vs. PSHs on EVT and clinical outcomes were analyzed using multilevel generalized mixed effect models. @*Results@#Out of 14,902 AIS patients, 2,180 (14.6%) were EVT candidates. Eighty-one percent of EVT candidates were transported by ambulance, but only one-third were taken initially to TCHs. Initial routing to TCHs was associated with greater chances of receiving EVT compared to initial routing to PSHs (33.3% vs 12.1%, P < 0.001; adjusted odds ratio [aOR], 2.21; 95% confidence interval [CI], 1.59–2.92) and favorable outcome (38.5% vs. 28.2%, P < 0.001; aOR, 1.52; 95% CI, 1.16–2.00). Inter-hospital transfers to TCHs occurred in 17.4% of those initially routed to a PSH and was associated with the greater chance of EVT compared to remaining at PSHs (34.8% vs. 7.5%, P < 0.001), but not with better outcomes. @*Conclusion@#Two-thirds of EVT candidates were initially routed to PSHs despite greater chance of receiving EVT and having favorable outcomes if routed to a TCH in Korea. Process improvement is needed to direct appropriate patients to TCHs.

Otorhinolaryngology Out-Patient Practice in the “Post”-COVID-19 Era: Ensuring a Balance Between Service and Safety

Objective@#To review available resources and provide evidence-based recommendations that may optimize otorhinolaryngologic out-patient health care delivery in the “post”-COVID-19 era while ensuring the safety of our patients, healthcare workers and staff.@*Data Sources@#Relevant peer-reviewed journal articles; task force, organizational and institutional, government and non-government organization recommendations; published guidelines from medical, health-related, and scientific organizations.@*Methods@#A comprehensive review of the literature on the COVID-19 pandemic as it pertained to “post”-COVID 19 out-patient otorhinolaryngologic practice was obtained from peer-reviewed articles, guidelines, recommendations, and statements that were identified through a structured search of the data sources for relevant literature utilizing MEDLINE (through PubMed and PubMed Central PMC), Google (and Google Scholar), HERDIN Plus, the World Health Organization (WHO) Global Health Library, and grey literature including social media (blogs, Twitter, LinkedIn, Facebook). In-patient management (including ORL surgical procedures such as tracheostomy) were excluded. Retrieved material was critically appraised and organized according to five discussion themes: physical office set-up, patient processing, personal protection, procedures, and prevention and health-promotion.@*Conclusion@#These recommendations are consistent with the best available evidence to date, and are globally acceptable while being locally applicable. They address the concerns of otorhinolaryngologists and related specialists about resuming office practice during the “post”-COVID-19 period when strict quarantines are gradually lifted and a transition to the “new” normal is made despite the unavailability of a specific vaccine for SARS-CoV-2. While they target practice settings in the Philippines, they should be useful to ENT (ear, nose & throat) surgeons in other countries in ensuring a balance between service and safety as we continue to serve our patients during these challenging times.

Patients experiences on the use of dihydroartemisinin piperaquine as an alternative first line artemisinin-based combination treatment for uncomplicated malaria in Northern Ghana

Background:Three different artemisinin-based combination therapies (ACTs) namely; artesunate-amodiaquine, artemether-lumefantrine and dihydroartemisinin-piperaquine (being the latest to be introduced) are concurrently being used forthe treatment of falciparummalaria in Ghana. This study assessed patients’ experience, perceptions and willingness to use dihydroartemisinin-piperaquine, brand name duo-cotecxin as an alternative first line ACT for the treatment of falciparummalaria in Northern Ghana.Methods:This was a qualitative study using phenomenology approach where sixty in-depth interviews were conducted with two groups; thirty patients who were given duo-cotecxin, one group and thirty interviews with patients who were given other ACTs (artesunate-amodiaquine, artemether-lumefantrine) as another group. The interviews were conducted between August and November, 2015 Purposive sampling technique was used to select study participants. The interviews were transcribed andcoded into themes using QSR NVivo 11 software for thematic content analysis.Results:All patients who used duo-cotecxin reported that the drug was very good in treating uncomplicated malaria compared to other ACTs they had used in the past. Some of the patients who used other ACTs could not complete their doses because of the side effects. However, none of the patients who used duo-cotecxin reported side effects. The findings revealed high acceptance and preference to use duo-cotecxin to treat uncomplicated malaria compared with other ACTs. All the participants were also willing to recommend duo-cotexcin to their relatives and friends to use. Conclusions: Duo-cotecxin as an alternative first line ACT for treatment of uncomplicated malaria is highly accepted, preferred and there was willingness to use it compared with other first line recommended ACTs.

In-Hospital and Post-Discharge Recovery after Acute Ischemic Stroke: a Nationwide Multicenter Stroke Registry-base Study

BACKGROUND: Using data from a large national stroke registry, we aimed to investigate the incidence and determinants of in-hospital and post-discharge recovery after acute ischemic stroke and the independence of their occurrence. METHODS: In-hospital recovery was defined as an improvement of 4 points or > 40% in the National Institutes of Health Stroke Scale (NIHSS) score from admission to discharge. Post-discharge recovery was defined as any improvement in the modified Rankin Scale (mRS) score from discharge to 3 months after stroke onset. Two analytic methods (multivariate and multivariable logistic regression) were applied to compare the effects of 18 known determinants of 3-month outcome and to verify whether in-hospital and post-discharge recovery occur independently. RESULTS: During 54 months, 11,088 patients with acute ischemic stroke meeting the eligibility criteria were identified. In-hospital and post-discharge recovery occurred in 36% and 33% of patients, respectively. Multivariate logistic regression with an equality test for odds ratios showed that 7 determinants (age, onset-to-admission time, NIHSS score at admission, blood glucose at admission, systolic blood pressure, smoking, recanalization therapy) had a differential effect on in-hospital and post-discharge recovery in the way of the opposite direction or of the same direction with different degree (all P values < 0.05). Both in-hospital and post-discharge recovery occurred in 12% of the study population and neither of them in 43%. The incidence of post-discharge recovery in those with in-hospital recovery was similar to that in those without (33.8% vs. 32.7%, respectively), but multivariable analysis showed that these 2 types of recovery occurred independently. CONCLUSION: Our findings suggest that, in patients with acute ischemic stroke, in-hospital and post-discharge recovery may occur independently and largely in response to different factors.

Knowledge of electromyography (EMG) among Sub-saharan African patients - a pilot survey

Background: Electromyography (EMG) is one of the common diagnostic procedure in neurology but still scarce in sub-Saharan Africa. Objective: This cross-sectional study evaluated the knowledge of EMG among patients undergoing this procedure, considering the type, quality and reliability of the information they have. Methodology: Consecutive patients who underwent EMG for the first time between 2014 and 2016, at the WFNR/Blossom Medical Centre Ibadan, Nigeria were interviewed prior to their test. Data on patient's demography, type of referring physicians were collated. Knowledge of EMG was also assessed. A patient was considered "informed" if she/he knew, at least, that the EMG is a test that uses an electric current or a needle, that it may be painful or cause discomfort, and that it is used to study the function of muscles and nerves. Descriptive and inferential statistics were performed to know the determinants of EMG knowledge. Result: 55 patients. 32 males and 23 females (mean ages 48.69± 18.32 and 43.30±14.88 respectively) were interviewed. Twenty-three (41.8%) patients were adjudged informed about the nature of EMG while 32 (58.2%) were uninformed about the procedure. Twenty one (38.2%) were informed about the procedure by their doctors while 4 (7.3%) got information from friends and relatives and 4 (7.3%) from the internet. Level of education was associated with being informed (p=0.039) Multivariate logistic regression analysis revealed no significant predictor or EMG knowledge. Conclusion: Knowledge of EMG is poor and could be improved upon. More patient education needs to be done to prepare the patients, and allay their fears about the procedure

Exercise for depression in older adults: a meta-analysis of randomized controlled trials adjusting for publication bias

Objective: To evaluate the antidepressant effects of exercise in older adults, using randomized controlled trial (RCT) data. Methods: We conducted a meta-analysis of exercise in older adults, addressing limitations of previous works. RCTs of exercise interventions in older people with depression (≥ 60 years) comparing exercise vs. control were eligible. A random-effects meta-analysis calculating the standardized mean difference (SMD) (95% confidence interval [95%CI]), meta-regressions, and trim, fill, and fail-safe number analyses were conducted. Results: Eight RCTs were included, representing 138 participants in exercise arms and 129 controls. Exercise had a large and significant effect on depression (SMD = -0.90 [95%CI -0.29 to -1.51]), with a fail-safe number of 71 studies. Significant effects were found for 1) mixed aerobic and anaerobic interventions, 2) at moderate intensity, 3) that were group-based, 4) that utilized mixed supervised and unsupervised formats, and 5) in people without other clinical comorbidities. Conclusion: Adjusting for publication bias increased the beneficial effects of exercise in three subgroup analysis, suggesting that previous meta-analyses have underestimated the benefits of exercise due to publication bias. We advocate that exercise be considered as a routine component of the management of depression in older adults.

Primary and Comprehensive Stroke Centers: History, Value and Certification Criteria / 대한뇌졸중학회지

In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention, acute treatment and quality improvement. In this invited review, we discuss a brief history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center.

Metallothionein or metallothionein like proteins and heavy metal toxicity in Oreochromis mossambicus (Peters).

Metallothioneins or metallothionein like proteins protect the biological system by encountering the influx of metal ions. These proteins are present in the contaminated as well as uncontaminated organisms. Studies show that the native metallothioneins or metallothionein like proteins of O. mossambicus is predominantly zinc bound. Increased influx of zinc causes a redistribution of this essential metal to other proteins requiring zinc as co-factor. Influx of mercury is encountered by the displacement of zinc bound to the protein and also by de novo of synthesis of metal binding proteins and subsequent binding of the incoming mercury. Data available show that "spill over" hypothesis is too simple to explain the mechanism of heavy metal toxicity.

Impregnation of biological specimes with resins and elastowers: plastination with biodur S 10 resin

Várias säo as desvantagens do uso de formaldeídeo, álcool glicerina e outros líquidos para a conservaçäo de peças anatômicas. O método da plastinaçäo se mostra superior aos métodos tradicionais de conservaçäo em líquidos e consiste de quatro etapas fundamentais: fixaçäo, desidrataçäo impregnaçäo e endurecimento. No presente foi utilizada a resina Biodur S10 adicionada do respectivo catalisador. As peças plastinadas resultantes apresentaram grande flexibilidade, aparência quase natural e de fácil manuseio

Dinámica gerencial: el arte de hacer que las cosas ocurran / Running things: the art of making things happen

Presentando sus ideas en forma entretenida e informativa, Crosby muestra cómo hacerse cargo de un grupo o de una organización; marcar objetivos claros y luego dirigir el grupo hacia el éxito. Describe exactamente lo que el líder debe hacer para que todos los miembros del grupo sepan lo que se espera de cada uno de ellos. También muestra cómo el líder puede crear un entorno en el que las personas se sientan motivadas para desempeñar con gusto su trabajo, por difícil que éste sea.

The hypolipidemic effect of onion (Allium cepa Linn) in sucrose fed rabbits.

Long term administration of sucrose significantly increased triglyceride levels in normal rabbits. Effects of an aqueous extract of onion on the sucrose fed rabbits have been investigated. Administration of onion extract significantly reduced serum, liver and aorta triglycerides and serum and liver proteins. On the other hand liver free amino acids have been significantly increased in the onion treated group as compared to the sucrose fed control. The effects of onion have been ascribed to its sulfur containing principles which oxidize thiol compounds either present free or combined in a protein and NADPH which are necessary for lipid synthesis.